Provider Demographics
NPI:1083622351
Name:HARDY, ROBERT GRANVILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GRANVILLE
Last Name:HARDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5068 W PLANO PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4408
Mailing Address - Country:US
Mailing Address - Phone:972-818-8080
Mailing Address - Fax:972-818-8485
Practice Address - Street 1:5068 W PLANO PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4408
Practice Address - Country:US
Practice Address - Phone:972-818-8080
Practice Address - Fax:972-818-8485
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice